Healthcare Provider Details

I. General information

NPI: 1073890836
Provider Name (Legal Business Name): SUNRISE HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12422 LUSHER RD
SAINT LOUIS MO
63138-1456
US

IV. Provider business mailing address

12422 LUSHER RD
SAINT LOUIS MO
63138-1456
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-1122
  • Fax:
Mailing address:
  • Phone: 314-355-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DENISE M HOOKS
Title or Position: OWNER
Credential:
Phone: 314-808-3658